Single soft tissue metastasis of MTC is extremely rare, although several case series show an unusual presenta- tion of distant metastases of MTC [6–8]. We searched the PubMed database using the keywords “medullary thyroid carcinoma or MTC”, “cutaneous or subcutane- ous metastasis,” and “soft tissue metastasis.” We found several cases reports of cutaneous metastasis of MTC [7, 8]. However, to our knowledge, this is the first report of MTC metastatic to soft tissue, and we emphasize that distant metastasis to soft tissue in patients with MTC is extremely rare. Based on a case series study, Glockner et al.  reported 11 patients with soft tissue metastases in a group of 1421 patients with a solitary mass over a 14- year period. An autopsy series suggested a higher inci- dence of metastasis to skeletal muscle , but indicated
distinguish between primary sarcoma and metastasis. Though cause of pain in soft tissue metastasis is not known, it may due to involvement of vasa nervosum, as metastasis is primarily by haematogenous route. The treatment strategy in metastasis of testicular cancers is markedly different because testicular tumours are more chemo sensitive compared with primary soft tissue sarcomas. In soft tissue metastasis, treatment options include observation, radiotherapy, chemotherapy, and excision. Excision may be indicated for selected patients with isolated soft tissue metastases, especially after a long disease free interval. Our patient was treated with wide excision because of isolated soft tissue metastasis. This is the fifth reported case of a testicular seminoma metastasizing to soft tissue. Our patient highlights the importance of distinguishing soft tissue metastasis from primary soft tissue sarcoma particularly who present with painful mass.
histological type of bladder cancer in the United States and Western Europe. While greater than 50% of UCC cases are non-muscle invasive with relatively good prognosis, soft tissue invasion and metastatic spread offer much worse outcomes.(2) The most common areas for metastatic spread of UCC are the lymph nodes, bones, lung, and liver. Advanced UCC has a poor prognosis with an overall five year survival of less than 15%.(3)
population that need to be taken into account. FDG uptake and resulting increased tracer activity is not limited to neoplastic tissue. Recognizing the strengths and weak- nesses of PET is important for the accurate interpretation of the PET/CT images. The diagnosis of ST metastasis in our study using combined PET/CT was relatively straight- forward as most lesions had significant FDG uptake higher than that of the liver which is a widely accepted ref- erence organ to distinguish benign from malignant lesions. Most PET facilities recommend at least 4 hours of fasting before the tracer injection as a standard. A longer fasting time may increase the detection of ST lesions; how- ever, the standard protocol of at least 4 hours fasting was followed in this retrospective study. PET/CT protocol in cancer staging usually comprises a low dose, non- enhanced CT protocol [17,18], which is sufficient for attenuation correction and anatomical information while keeping the radiation exposure to a minimum. Given the low-dose and non-contrast enhanced protocol, the CT portion of the study helped localize the lesions and increase the diagnostic confidence as ST metastatic lesions can appear hyperdense or hypodense as compared to the surrounding soft tissue.
Imaging by fluorine 18-fluoro-2-deoxy-glucose-positron emission tomography (18F-FDG-PET; Fig. 4, 5) scans showed cervical hypermetabolic foci along the nerve-ves- sel-sheaths of both sides that were suspect for malignancy and assessed as metastases with regard to sensitivity and specifity of PET and CT scan. Multiple metastatic lesions were also present in the lung. Furthermore, foci that were suspect for metastases were also found unilaterally in the muscular system of both the left part of the back and left anterior thoracic wall. On the basis of these rather atypical findings, we performed a total body CT in order to exclude the simultaneous presence of a second malignoma. Altogether, one suspect soft tissue metastasis could be identified near the left upper ventral thoracal wall (Fig. 6). Contrast enhanced CT, soft tissue window: Tumor of the
In laboratory studies, a hematological examination showed increased white blood cell and platelet counts. The chemical analysis showed an increase in the CRP- level. The tumor markers were all within the normal lim- its except for the soluble interleukin 2 receptor. Our cli- nical diagnosis was a multifocal abscess. We treated the patient with antibiotics, but his clinical findings did not improve. We therefore suspected a neoplastic condition, and a needle biopsy from the elbow lesion was per- formed. Histopathological specimens showed tumor cells with large nucleoli, and the tumor cells had a ductual structure (Figure 5). In the immunochemical study, cy- tokeratin was positive in the tumor cells, so the patho- logical diagnosis was a metastasis of the soft tissue from adenocarcinoma. The final diagnosis was lung cancer with soft tissue metastasis.
changes are highly correlated. Altemus LA, in his study, found that facial balance and harmony are often in com- promised or compensated in relationship with skeletal, dental and soft tissue component of the face . Dental factors, such as the inclination of upper and lower anterior relative to the palatal and mandibular plane, respectively, affects the lip positions. The movement of the cervical point of the upper incisor or the incisor retraction with translator movement greatly influenced changes in the UL position in the horizontal plane . As many of the reference lines used for facial analysis pass through the nose and chin, growth and morphology of the nose and chin would greatly affect the lip position. Ricketts E line should be read in relation to the nose and chin. Ricketts E line is influenced by the growth of the nose. Whereas Steiner’s S1 line eliminates half of the changes in integument profile due to the growth of the nose. Nasal growth is eliminated in H line, B line and Sushner line. The relation of the lip with the B line depends on the thickness of the lip and correct position of lips. When lips are equally thick, B line is more reliable. Both chin and nasal position influence the horizontal lip position [16,26,27]. In Turkish adult, significant differences in soft tissue thickness among skeletal malocclusions were observed for the labrale superius, stomion and labrale inferius sites. Moreover, soft tissue thickness at all sites was greater in men than in women .
Large mass- incisional biopsy with a longitudeinal incision (extremity lesions) to facilitate subsequent wide local excision. Incision should be centered over the mass at its most superficial location. Care should be taken to raise flaps. Meticulous hemostasis should be ensured to prevent dissemination of tumor cells into adjacent tissue planes.
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The differential diagnosis of the tumor includes a variety of tumors including superficial angio- myxoma, cellular angiofibroma, myxoid liposar- coma, low-grade fibromyxoid sarcoma, low- grade myxofibrosarcoma and solitary fibrous tumor. Superficial angiomyxoma contained abundant delicate thin-walled vessels and myx- oid matrix. The presence of inflammatory cells, particularly neutrophils and the expression of CD34 could helpful for confirming the diagnosis . Cellular angiofibroma mainly occurred in the genital region, was characterized by small- to medium-sized vessels with mostly hyalinized walls and usually lacking branching vascular network . Myxoid liposarcoma was charac- terized by prominent plexiform “chicken wire” capillaries. Compared to myxoid liposarcoma, the vessels in angiofibroma of soft tissue were thicker and more heterogeneous, which was helpful for differential diagnosis . Low- grade fibromyxoid sarcoma could also show Table 2. Review of immunohistochemical staining of angiofibroma of soft tissue (cases from previous publications and the current case)
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Also utilized was microcurrent injury detection, which from previous research, demonstrates strong correlation to other objective measures of injury, including diagnostic ultrasound and blood tests [17-20]. This detected 60% or greater decreased conductance, consistent with tissue injury, [17,18,20] at the glenohumeral (GH) joint, long head of the triceps, and pectoralis minor during the course of treatment.
angiogenesis inhibitor, in patients with relapsed or refractory advanced soft tissue sarcoma: a phase II study from the European organisation for research and treatment of cancer-soft tissue and bone sarcoma group (EORTC study 62043). J Clin Oncol, 27 (2009), pp. 3126–3132.
Abstract: Liposarcoma (LPS) is the most common type of soft-tissue sarcoma. Complete surgical resection is the only curative means for localized disease; however, both radiation and conventional cytotoxic chemotherapy remain controversial for metastatic or unresectable disease. An increasing number of trials with novel targeted therapy of LPS have provided encouraging data during recent years. This review will provide an overview of the advances in our understanding of LPS and summarize the results of recent trials with novel therapies targeting different genetic and molecular aberrations for different subtypes of LPS.
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Cellulitis is the most common type of soft tissue infec- tion and confined within the subcutaneous compart- ment. Cellulitis is a clinical diagnosis. Patients may have fever, chills, and leukocytosis in addition to red- ness, swelling, local heat, and swelling on the infected sites. A sonographic cobblestone-like appearance is composed of a hyperechoic, hyperemic pattern of the inflamed subcutaneous fat intersecting by anechoic fluid along the connective tissue (Additional file 3: Video 3). However, a cobblestone-like appearance only indicates inflamed tissue and is nonspecific for cellulitis.
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The excellent repeatability, particularly median and mean ADC, indicates that ADC is a robust metric in clinical studies in retroperitoneal sarcomas. ADC repeatability was better than in some other extra-cranial soft-tissue tumors, where CoVs up to 7% have been observed (23). Retroperitoneal sarcomas also exhibit good repeatability of other ADC centile values (10th to 90th centiles), in agreement with studies in other solid tumors (24). Good baseline repeatability confers high sensitivity to post- treatment changes, as demonstrated by the significant ADC increase post-radiotherapy. A post-treatment increase of 7.1% in median ADC would be outside the upper 95% LoA, indicating a change outside the expected variation of repeated measurements. The correlation between restricted diffusion (low ADC or D) and high cellularity (high nuclear-to-stromal ratio) demonstrates that the degree of restricted diffusion relates to the density of tumor cells. A similar relationship between ADC and cellularity was observed previously in soft-tissue sarcomas (25). However, the present study suggests that the relationship is more complicated than a simple correlation owing to the differences in ADC or D between stroma types and stroma grades. ADCs of myxoid and fibromyxoid regions are high compared with other tumor types, while low ADCs may be indicative of fibrous regions.
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Abstract: Sarcomas are a heterogeneous group of solid tumors arising from either soft tissues or bone, accounting for approximately 1% of all cancers in adults. Management of these diseases has changed little over the past 10 years, with the exception of treatment of gastrointestinal stromal tumors. Reasons for this stagnation include multiple histologies commonly grouped together in clinical trials limiting the understanding of benefit of treatment and limited inves- tigation of molecular targeted therapies. More recently, advances in molecular pathogenesis, the advent of novel and targeted therapeutics, and increasing collaborations between sarcoma investigators has helped move the field forward in the right direction. Here, we review the recent data on novel agents tested for the management of adult soft-tissue sarcomas, excluding gastrointestinal stromal tumors.
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A 24-year old man, a car driver, was admit- ted to our hospital for upper leg injury with a 10 cm defect in the tibial bone. We found also skin loss & soft tissue injury.We used the right latis- simus dorsi muscle and rib beneath it with vas- cular pedicle and two levels up of nonvascular- ized ribs were also harvested. After vascular anastomosis to the popliteal vessels external fixation was used. The patient had an unevent- ful postoperation period. Three months later he
significant periosteal proliferation made it difficult to rule out a malignant tumor, especially Ewing’s sarcoma and Langerhans’ cell histiocytosis. In CRMO involving tubular bones, abscess formation and soft tissue inflam- matory changes are generally absent, whereas in this case there was mild soft tissue inflammation, making it difficult to rule out infectious osteomyelitis. MRI is sen- sitive to the bone marrow edema and soft tissue inflam- matory changes seen in CRMO, but these findings are nonspecific.
surgery can generally be performed in a two-team ap- proach with a low donor site morbidity [8, 9]. Further- more, complex tongue defects involving the tongue and the floor of the mouth require accurate multiplanar con- figuration of flap design and tailoring. The flap design is the key point in both preserving mobility and providing neotongue bulk. The purpose of this study was to de- scribe the ALT flap supplied by a single perforator for soft tissue reconstruction in 39 cases with tongue cancer and to evaluate the survival characteristics of this flap.
Previous studies [7, 11, 12] were undertaken to scrutinize the factors influencing the soft tissue profile changes by means of correlation between the hard and soft tissue changes after treatment. The result indicated that prediction of the upper lip response from incisor position after treatment was low predictable. Therefore, the objective of this study was to investigate the follow- ing factors: pretreatment dento-skeletal and soft tissue morphology, age, sex and treatment modality that relate to the soft tissue changes. The results of the study should verify the soft tissue profile changes following orthodontic treatment in Class II Division 1 malocclu- sion and suggest the proper treatment modalities for the individual patient.
Lasers, which were first used in dentistry in 1960, are now an integral part of the dental practice. They are used in cavity preparation, surgical procedures and various other procedures. They can be used not only as adjunct but also as an alternative to conventional techniques. Soft tissue lasers can be put to use for a number of treatment options in periodontics. Here are case series